Rural Health Care District exploring idea of a Critical Access Hospital for Sublette County
Hiring a feasibility study of the legal and financial implications
December 25, 2014
The Sublette County Rural Health Care District (SCRHCD) is continuing to explore the idea of building a 24-hour staffed Critical Access Hospital (CAH) in Pinedale to serve Sublette County.
The SCRHCD, Sublette Center, and the Sublette County Commissioners have entered into a Memorandum Of Understanding (MOU) to jointly explore the legal and financial implications of three scenarios. These include looking at both the Health District and the Sublette Center continuing to operate independently and the third option of the Health District and the Sublette Center entering into a partnership.
The feasibility study is being completed by three different entities. They include: Jeff Fivecoat, Baird, assessing legal and financial implications; DZA performing a 5-year financial performance study; and Blue Room Architects developing a conceptual plan and the associated costs of construction. It is anticipated that this combined study will be completed by April 1, 2015. This information will be shared with the community once available.
A Critical Access Hospital is a Medicare-participating hospital that meets special criteria to be designated as a CAH. That criterion includes:
- Must be located more than 35 miles from any hospital or another CAH
- Must furnish 24-hour emergency care services
- Has 4 – 25 inpatient beds
- Annual average length of stay of 96 hours or less
With this limited size and short length of stay, most CAHs focus on providing care for common conditions and outpatient care, while referring other, more critical or acute conditions to larger hospitals such as St John’s in Jackson, Eastern Idaho Medical Center in Idaho Falls, or Sweetwater Memorial in Rock Springs. Regionally, there is also a smaller hospital located in Kemmerer whose services are utilized by some Sublette County citizens.
It is proposed that the new CAH would be an expansion of the Pinedale Clinic. This expansion would include 4 - 6 patient rooms near the current emergency department to maintain access to critical services such as lab and radiology. This would also allow shared clinical staff between the hospital and the emergency department.
The Rural Health Care District operates two medical clinics (one in Pinedale and one in Marbleton), county-wide EMS ambulance services, medical staffing, and administration staff. The District is overseen by a publicly-elected board of trustees and managed by paid staff. The SCRHCD is largely financed by a 2 mil tax levy and income from their clinic visits, ambulance and medical services.
According to their 2013-2014 annual report, their annual operating expenditures are over $11.5 million. For the past two years the SCRHCD has operated at a financial loss. In 2013-2014 they overspent beyond their revenue by $1.3 million and had to dip into their savings to cover the overage. Based on their projected income and if they continue their present level of spending and operations, the Health Care District reports they will deplete their reserves within five years to provide their current services.
The benefits of a CAH in Sublette County include keeping health care closer to home for patients and their families. The CAH could do outpatient care including lab and radiology services, overnight stay for observation after a concussion, IV fluids for hydration, acute pain management, IV antibiotics, treatment of acute infections or fluid management for someone with congestive heart failure. It would not provide surgical or maternal child services.
With a CAH, they would also have access to grant monies. They could take advantage of recently passed rural health care legislation that would allow the District to receive cost-based reimbursement from Medicare for their services which could bring in as much as $2.5 million in additional funds.
Figures for the cost of building construction, additional staffing, and operating expenses for the larger 24-hour facility are not yet known.
For more information, contact:
Pinedale Clinic: Dr Kappenman, or Malenda Hoelscher, HCA) at 307-367-4133
Marbleton Clinic: Dr Albritton, Dr Burnett, or Lorraine Gatzke-CFO at 307-276-3306
Sublette Center: Dawn Walker-Adm; or Jay Majhanovich, Chairman of the Board, at 307-367-4161
Or go online to:
Critical Access Hospital Questions & Answers
www.sublettehealthcare.com SCRHCD
www.hrsa.gov
See below for a release from the SCRHCD:
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Join the conversation…
What is a Critical Access Hospital (CAH)?
The History behind Critical Access Hospitals
Critical Access Hospitals became popular in rural areas after legislation was enacted in 1997. The purpose of this legislation was to strengthen rural health care and provide access to needed services in rural areas. With almost one fifth of the US population living in rural areas, Critical Access Hospitals have provided vital services in rural areas across the country. The state of Wyoming is not exempt. Wyoming is home to sixteen Critical Access Hospitals. They exist in communities such as Basin, Lusk, Cody, Lovell, Wheatland and Afton. Sublette County is the only county in Wyoming without hospital services.
What is a CAH?
A Critical Access Hospital is a Medicare-participating hospital that meets special criteria to be designated as a CAH.
That criterion includes:
-Must be located more than 35 miles from any hospital or another CAH
- Must furnish 24-hour emergency care services
- Has 4 – 25 inpatient beds
- Annual average length of stay of 96 hours or less
With this limited size and short length of stay, most CAHs focus on providing care for common conditions and outpatient care, while referring other, more critical or acute conditions to larger hospitals such as St John’s, Eastern Idaho Medical Center or Sweetwater Memorial.
What are the Benefits of having a CAH in Sublette County?
Since the development of CAHs in the late nineties, rural communities and health care facilities alike have experienced the benefits of having a Critical Access Hospital designation. These benefits include a greater focus on community needs and keeping health care close to home, networking with acute care hospitals for support with emergent and critical care, access to grant monies made available through rural health care legislation, opportunity for cost-based reimbursement from Medicare which has the potential to boost revenue (close to 2.5 million dollars annually), enhanced quality of care as Critical Access Hospitals need to meet certain licensing and survey requirements to operate and lastly, opportunity for increased jobs in the community which has the potential to increase revenue to the community.
With Sublette County being the lone county in Wyoming without these benefits, the Rural Health Care District is exploring the possibility of having a community Critical Access Hospital; in addition to our current clinics and services in Pinedale and Marbleton/Big Piney.
Where would the Critical Access Hospital be?
It is anticipated that the Critical Access Hospital would be an expansion of the Pinedale Clinic—not a new building. This expansion would include 4 - 6 patient rooms near the current Emergency Department to maintain access to critical services such as lab and radiology. This would also allow shared clinical staff between the hospital and the emergency department.
What type of care would be provided in the Critical Access Hospital?
Due to the limited size and short stay length allowed in CAHs, the focus would be on providing care for common medical conditions as well as outpatient care including lab and radiology services. Common conditions could include overnight observation after a concussion, IV fluids for hydration, acute pain management, IV antibiotics for an acute infection of fluid management for someone with Congestive Heart Failure. It would not provide surgical or maternal child services.
Why does it make sense for the Health District to explore this option?
Over the past two years, the Health District has experienced a deficit budget and the projectory of providing our current services, the cost associated with those services, the decreasing mil and changes to reimbursement from Medicare, Medicaid and insurances, the Health District’s reserves will be expended in 5 years. Certification as a CAH allows for cost-based reimbursement from Medicare instead of standard fixed reimbursement rates. This cost-based reimbursement would not impact visits to the clinic but services associated with a hospital including lab, radiology, emergency room visits, ambulance transport, etc… It is our goal to keep Sublette County residents in Sublette County.
How does this impact the Sublette Center?
This is a hard question to answer at this time. But what we know is that the CAH will provide medical care to a resident of the Center if they develop an acute illness vs traveling out of the county. We also know that Critical Access Hospital’s can provide transitional care also referred to as Medicare A stay or Swing Bed status. This transitional care allows a Medicare patient to receive skilled nursing care and/or therapy services. Currently the Sublette Center provides that service to our community. In addition, the Sublette Center has services that the Critical Access Hospital could utilize to avoid duplication and cost. Those services could include dietary, laundry, and physical therapy.
What would this mean for the Marbleton/Big Piney Clinic?
It is the goal that services remain the same, if not enhanced. As the Health District continues to move through the exploratory process we are looking at a system of health care and what services are best provided in which clinic. The addition of digital mammography and/or outpatient procedures such as colonscopy is being considered at the Marbleton/Big Piney Clinic.
What is the next step?
The Health District, the Sublette Center, and the County Commissioners have entered into a Memorandum of Understanding to jointly explore the legal and financial implications of three scenarios. These include looking at both the Health District and the Sublette Center continuing to operate independently and the third option of the Health District and the Sublette Center entering into a partnership. This feasibility study is being completed by three different entities. They include: Jeff Fivecoat, Baird (assessing legal and financial implications), DZA (performing 5 year financial performance study) and Blue Room Architects (developing a conceptual plan and the associated costs of construction). It is anticipated that this combined study will be completed by April 1st, 2015. This information will be shared with the community once available.
To learn more about Critical Access Hospitals, go to:
http://sublettehealthcare.com
http://www.hrsa.gov
Who can I contact if I have a question or would like more information?
Pinedale Clinic (Dr Kappenman-Malenda Hoelscher, HCA) at 307-367-4133
Marbleton Clinic (Dr Albritton-Dr Burnett-Lorraine Gatzke, CFO) at 307-276-3306
Sublette Center (Dawn Walker, Adm- Jay Majhanovich, Chairman of the Board) at 307-367-4161
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